Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
Center for Higher Education Development, University of Cape Town, Cape Town, South Africa.
J Surg Educ. 2023 Oct;80(10):1462-1471. doi: 10.1016/j.jsurg.2023.06.027. Epub 2023 Jul 13.
Before proceeding with local implementation of competency-based medical education-related assessment practices designed and evaluated in the Global North, we sought to challenge the assumption that this would be perceived as both necessary and acceptable in our context where training and assessment is based on a traditional, knowledge-focused approach. The aim of this study was to determine the perspectives of general surgery trainees and consultants towards the assessment of competence, how this has been achieved previously, and how it should be performed in the future at the University of Cape Town (UCT), South Africa.
Semi-structured interviews were conducted with consultants and trainees. Interviews were transcribed and then analyzed using a Reflexive Thematic Analysis approach.
Ten consultants (5 senior and 5 junior) and 10 trainees (5 South African and 5 international) from the Division of General Surgery at UCT in August 2022.
Five unique themes were developed: (1) Assessment of competence is essential, (2) competence includes multiple domains of practice, (3) a surgeon must be able to operate, (4) previously used methods were inadequate to assess competence, and (5) frequent assessment with feedback is desired. The themes were considered in the context of Situated Learning Theory, particularly Communities of Practice and their role in the training for, and authentic assessment of, competence in general surgery trainees.
Participants described a need to develop and implement a new competency assessment program for general surgery training in this context, which is aligned with described competency-based medical education principles. Thoughtful integration of the formative and summative use of direct observation in the workplace, with a clear emphasis on procedural ability and the provision of high-quality feedback, may enhance the successful implementation of a strategy for competency-based assessment in general surgery training programs.
在全球北方设计和评估的基于能力的医学教育相关评估实践进行本地实施之前，我们试图挑战这样一种假设，即在我们的培训和评估基于传统的、以知识为重点的方法的背景下，这将被视为既必要又可接受的。本研究旨在确定南非开普敦大学（UCT）普通外科受训者和顾问对能力评估的看法，他们之前是如何做到这一点的，以及未来应该如何在UCT 进行。
对顾问和受训者进行了半结构化访谈。访谈记录下来，然后使用反思性主题分析方法进行分析。
2022 年 8 月，UCT 普通外科系的 10 名顾问（5 名高级顾问和 5 名初级顾问）和 10 名受训者（5 名南非受训者和 5 名国际受训者）。
确定了五个独特的主题：（1）能力评估是必要的，（2）能力包括实践的多个领域，（3）外科医生必须能够进行手术，（4）以前使用的方法不足以评估能力，（5）需要频繁评估和反馈。这些主题是在情境学习理论的背景下考虑的，特别是实践共同体及其在普通外科受训者培训和能力真实评估中的作用。
参与者描述了在这种情况下需要为普通外科培训开发和实施新的能力评估计划，这与描述的基于能力的医学教育原则一致。在工作场所中深思熟虑地整合直接观察的形成性和总结性使用，并明确强调程序能力和提供高质量的反馈，可能会增强在普通外科培训计划中实施基于能力的评估策略的成功。
